MEDICARE: DR. DAVID J FIORELLA M.D., PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085N0700X	Neuroradiology Physician	29194	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7930204	OTHER	NY	AETNA PPO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	252328	OTHER	NY	HIP
4	116754	OTHER	AZ	PTAN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467416271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID J FIORELLA M.D., PH.D.

Provider Business Mailing Address
First Line	:	HSC T12 RM 080
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11794-8122
Country	:	US
Telephone Number	:	631-444-1213
Fax Number	:	631-444-1535

Provider Business Practice Location Address
First Line	:	HSC T12 RM 080
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11794-8122
Country	:	US
Telephone Number	:	631-444-1213
Fax Number	:	631-444-1535

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	08/15/2014

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